Dermatology Online Journal

Surgical and non-surgical treatment modalities for lymphangioma circumscriptum

Scalp metastasis as initial presentation of neuroendocrine carcinoma

Neuroendocrine carcinomas are a rare, heterogenous group of malignancies that arise from neuroendocrine cells throughout the body. Cutaneous metastasis of neuroendocrine carcinoma is uncommon and they can be easily misdiagnosed as benign epidermal cysts or Merkel cell carcinoma. Collectively, histopathology, immunochemical profile, biochemical markers, and nuclear imaging can guide the diagnosis of neuroendocrine metastasis and localization of primary tumors.

Cutaneous metastasis as a first sign of adenocarcinoma of the cervix

Cervical cancer remains one of the most common malignancies diagnosed in women as well as a leading cause of cancer related deaths in women worldwide. Cutaneous metastasis associated with cervical malignancy is a remarkably rare phenomenon. We present a patient whose cutaneous signs led to the diagnosis of metastatic adenocarcinoma of the cervix.

Reactive granulomatous dermatitis associated with ovarian cancer and a review of its role as a harbinger for malignancy

Reactive granulomatous dermatitis (RGD) is a rare dermatosis with a variety of cutaneous manifestations unified by a dermal granulomatous infiltrate on histology. Rheumatoid arthritis and autoimmune disease are classic associations, but an increasing number of cases have been attributed to covert malignancy. Only 41 cases of paraneoplastic RGD have been documented to our knowledge and we present an additional case that manifested eight months prior to the diagnosis of ovarian cancer and clinically mimicked morphea. Histopathologic examination identifying palisaded CD68+ cells and collagen degeneration are helpful in diagnosing this entity which may mimic a host of other cutaneous processes, including metastatic disease. Cancer-directed therapies have been successful in clearing paraneoplastic RGD with or without the addition of corticosteroids, as RGD severity may be driven by the underlying malignancy. This case highlights the importance of utilizing histopathology to confirm the diagnosis given its nonspecific clinical findings, as well as the importance of considering malignancy and metastatic disease in patients diagnosed with RGD regardless of their cancer history.

Cutaneous metastasis of high-grade serous adenocarcinoma secondary to a gynecological malignancy

Cutaneous metastases from malignancies of gynecological origin are rare but have been described over the vulvovaginal area in the setting of ovarian, endometrial, and fallopian tube neoplasia. We present an 89-year-old woman with multiple non-tender, fleshy, skin-colored nodules with central ulceration and bleeding over the mons pubis. Skin biopsy and immunohistochemistry of these tumors were in keeping with metastatic high-grade serous adenocarcinoma secondary to a gynecological malignancy. This brief report aims to raise physician awareness about this rare skin presentation, which is unfortunately associated with a poor prognosis.

Cutaneous metastasis of serous ovarian carcinoma

Ovarian carcinoma ranks among the top causes of cancer-related fatalities among women in the United States [1]. In the spectrum of ovarian carcinomas, low-grade serous ovarian carcinoma (LGSOC) is a relatively rare form, constituting only 2-5% of all ovarian carcinomas [2]. Although metastasis to the peritoneum and other organs is frequently observed, cutaneous metastasis of ovarian carcinoma is uncommon, occurring in less than 4% of cases and occurring even less often in the serous subtype [3]. Owing to its rare and variable presentation, cutaneous involvement in ovarian carcinoma is particularly challenging to recognize. Patients presenting with skin lesions in the setting of a history of ovarian carcinoma should raise suspicion for cutaneous metastasis. We present a rare case of LGSOC with non-nodular cutaneous involvement presenting as asymptomatic erythematous papules and hyperpigmented patches on the upper chest, abdomen, and lower back.

Microcystic lymphangioma of the vulva

Cystic cutaneous lymphatic malformations are developmental anomalies of the lymphatic system characterized by lymphatic vessel dilatation. Microcystic forms, also known as circumscribed lymphangiomas, present as clusters of translucent or hemorrhagic vesicles, papules, or infiltrated plaques, often appearing in early childhood and primarily affecting the proximal extremities. Although generally asymptomatic, they may cause inflammatory, infectious, or hemorrhagic episodes. We report a 39-year-old woman with a 2-year history of vesicular lesions on the medial surface of both labia majora associated with intermittent pruritus and fluid leakage. Clinical examination revealed bilateral painless swellings, each approximately 6 cm, with translucent and hemorrhagic vesicles. Histology confirmed bilateral subcutaneous microcystic lymphangiomas. Given their benign nature, no treatment was recommended aside from surveillance. Microcystic lymphangiomas have an unpredictable course, with some remaining stable and others developing complications requiring treatment. Management depends on lesion location, symptoms, and esthetic impact, with options including sclerotherapy, CO₂ laser, or surgical excision if necessary. This case highlights the importance of accurate diagnosis and individualized treatment of microcystic lymphangiomas.